Medicine Needs To Abandon Many Ineffective Therapies; Example
$25 Billion of Heart Drugs Donít Prevent Cardiovascular Death!
by Bill Sardi: Oh-No-bamacare
medical subspecialties in American Medicine exist largely upon treatments
that are ineffective but never abandon them, a Northwestern University
researcher is calling attention to the many scientific reports that
do not support the scientific underpinnings for many therapies such
as implantation of stents in coronary arteries and use of cholesterol-lowering
MD and Andrae Vandross MD, of the Department of Medicine at Northwestern
University in Chicago, are calling physicians to "abandon the
cholesterol pill ship"; $25 billion of cardiac drugs donít
prevent cardiovascular death among millions of high risk but otherwise
healthy adults. So says a special report published in the April
23, 2012 issue of The
Archives of Internal Medicine, a report that has received
no news media coverage.
In an era
when Obamacare is going to be ushered in to reduce needless healthcare
spending, the public should begin to wonder if so-called miracle
drugs like Lipitor, which have arrogantly been marketed as "science-based"
and "FDA-approved," actually reduce the risk for deadly
The practice of prescribing cholesterol-lowering drugs started
with Mavacor in the early 1980s. The problem was then, as now,
is that what is called a "surrogate marker" of heart and
blood vessel disease was used in place of conclusive evidence that
it prevents mortal heart attacks Ė the gold standard of all cardiac
drugs. Does it save lives or does it just give false hope that a
mortal heart attack wonít occur at some time in the future?
In a recent
analysis of 11 controlled published studies involving 65,229
healthy patients that covered a period of 1970-2009, reviewers said
they "did not find evidence for the benefit of statin drug
therapy on all-cause mortality in a high-risk primary prevention
group." Statin drugs lower cholesterol production in the liver
and are the most commonly-prescribed class of cholesterol-lowering
otherwise healthy adults who had a family history of heart disease
or had other factors like high blood pressure or health habits like
smoking that placed them in a higher risk grouping for mortal heart
cardiac drugs are not totally without side effects, if the only
benefit is the reduction of a number that measures circulating levels
of blood fats (cholesterol), and otherwise healthy patients are
just being put at risk to develop side effects (statin drugs are
toxic to the liver), just exactly why do cardiologists continue
to prescribe them? Many patients recount encounters with their cardiologist
where they were sternly warned if they do not take this pill they
could die suddenly of a heart attack. But the data says statin drugs
only prevent non-mortal heart attacks in relatively healthy patients
who take statins for prevention.
the fear of a mortal consequence from not following the doctorís
advice is likely what prompts patients to comply and habitually
take cholesterol-lowering drugs, and return to the doctorís office
for a renewal of their prescription. Many a patient recounts to
me that their cholesterol umber is low, 160, and they feel good
about that. But they are no less at risk for a sudden-death heart
attack than others who donít take a statin drug.
reduction: a moving target
In 2006 a US
Air Force physician, Brian K Crownover MD, asked when the "end
of the statin drug gold rush" would occur? Dr. Crownover took
the cholesterol-lowering drug companies to task and asked just
when were they going to stop moving the target so their drugs could
be put to the test. First the effectiveness of cholesterol drugs
was measured by total cholesterol in the blood. Then the target
moved to reduction of LDL "bad" cholesterol (low-density
lipoproteins). Then more recently the objective was to raise HDL
"good" cholesterol (high density lipoproteins). Only this
year (2012) has it been revealed that elevation
of HDL "good" cholesterol does not reduce cardiac mortality.
said, at the time, that just when the patents expired on one cholesterol-lowering
drug and lower cost generic versions were going to have an opportunity
to reduce drug costs, "there was a shift to manage new targets,"
he lamented. He said, at that time, that physicians "eagerly
await outcomes data (number of deaths) in the hopes of establishing
the cost effectiveness of these new drugs prior to their expected
dominance in the marketplace." Those words were spoken in 2006
and billions of statin drugs are still being prescribed.
MD and Andrae Vandross MD, of the Department of Medicine at Northwestern
University in Chicago, authors of the landmark report published
in the Archives
of Internal Medicine mentioned at the top of this report,
advocate "setting the bar high" for future approval of
cardiac drugs. That is to say, stop using blood markers of disease
that are assumed to correlate with cardiac death and conduct a more
intensive study to see if these drugs do or do not save lives.
storm clouds gathering around the entire idea of employing cholesterol-lowering
drugs, the question the authors ask is just how does modern medicine
prepare to "abandon ship?" Cholesterol-phobia drives millions
of patients to doctorsí offices. It is a cash-cow.
And itís not
just statin drugs that come under scrutiny, but ANY agent that lowers
cholesterol, such as Zetia (ezetimibe), the drug that attempts to
reduce cholesterol absorption from the diet, Tricor (fenofibrate),
a drug that raises statin concentration in the blood, or even the
oft-beloved niacin, which is touted to be a natural way to raise
and VanDross say: "Recent trials in cardiovascular medicine
have contradicted current medical practice." They state: "even
long-established preventive practices may be erroneous."
They go on
to say: "What is at stake in cardiovascular prevention is no
small matter. Statins cost Americans over $19 billion in 2005 and
two other cholesterol-lowering drugs another $5 billion."
and Vandross then unload another bombshell. Not only are millions
of people screened for elevated cholesterol unnecessarily, they
say: "regarding campaigns to screen for breast, prostate, and
colon cancer to decrease cancer-specific death, none have shown
an overall mortality benefit in prospective trials." Good God,
how much of modern medicine is nothing more than a costly and deadly
disease prevention for death
Then Drs. Prasad
and Vandross point to yet another sad fact. In their words: "At
a minimum, however, it is reasonable to ask that lives saved from
cancer are not traded for increased deaths from non-cancer causes
or overwhelming morbidity. For instance, a recent study indicates
the very announcement of a diagnosis of prostate cancer dramatically
increases the risk for a heart attack or suicide.
They were referring
to a review
conducted in Sweden where more than 4 million men were screened
for prostate cancer and found, during the first week after detection
of prostate cancer, the risk for a heart attack rose 2.8 to 11.0-times
and the risk for suicide rose by 8.4-fold. The sad fact is that
many of these diagnoses were false positives (they didnít have prostate
cancer at all) and for most of the rest, prostate cancer wasnít
a death sentence, it was something they were going to die with,
medicine ever abandon outmoded practices?
to the above question is yes, but rarely and often begrudgingly,
and having friends in government helps. For example, for years physicians
believed that excessive stomach acid caused gastric ulcers. Antacids
were prescribed and patients were advised to reduce stress. But
then Australian doctors Barry J. Marshall and J. Robin Warren, who
won a Nobel Prize for this in 2005, discovered
that a bacterium (H pylori) caused stomach ulcers. But the antacid
drug that was prescribed for this condition continued to be sold
and prescribed until its patent wore off and only then did the FDA
prod doctors to abandon the antacid drug. Profits are creating false
realities in medicine.
in a report entitled "Reversals
of Established Medical Practices; Evidence to Abandon Ship,"
published in a January 2012 issue of The Journal of the American
Medical Association, says:
good medical practices are replaced by better ones, based on robust
comparative trials in which new interventions outperform older
ones and establish new standards of care. Often, however, established
standards must be abandoned not because a better replacement has
been identified but simply because what was thought to be beneficial
was not. In these cases, it becomes apparent that clinicians,
encouraged by professional societies and guidelines, have been
using medications, procedures, or preventive measures in vain."
subspecialties may be a charade
goes on to ask: "How many established standards of medical
care are wrong?" He says: "It is possible that some entire
medical subspecialties are based on little evidence. Their disappearance
probably would not harm patients and might help salvage derailed
I suspect Dr
Prasad is correct. And the most deadly diseases, cancer and heart
disease, where physicians can more easily manipulate patients over
the fear of dying, are the most likely medical specialties to lack
strong scientific evidence for many of the treatments offered.
points to stents used to prop open coronary arteries, for which
there is no evidence these arterial implants lower mortality, but
they do reduce chest pain (angina). So Dr. Prasad says stents have
ended up being "an expensive placebo for pain control."
of coronary arteries, Dr. Prasad speaks boldly when he says: "Despite
the evidence, many specialists will not abandon the procedure."
He says the
first generation of patients who undergo these unproven treatments
"receive all the risk of treatment and no real benefits."
Second, "contrary studies do not immediately force a change
in practice." And third, "the contradicted practice continues
for years." Imagine if the insurance billing code was withdrawn,
just how many doctors would continue to prescribe these ineffective
Dr. Prasad, the disproven practice "undermines trust in the
healthcare delivery system." Yes, maybe, but so many Americans
have been misled to believe American medicine is the best in the
world. Patients arenít ready to believe anything contrary to that.
Who or what
will ever disengage doctors from these disproven therapies? State
medical boards donít. The American Medical Association wonít. Medicare
and private insurance keep paying for these services. The band keeps
playing. Naïve patients blindly desire more treatment that
they feel they paid for with their insurance premiums and Medicare
will disclose which therapies are ineffective, but belatedly. Dr.
Prasad warns: "Asking corporate sponsors to conduct pivotal
trials on their own products is like asking a painter to judge his
or her own painting so as to receive an award. If a manufacturer
can be allowed to manipulate the system to create a blockbuster
product from an ineffective drug, the temptation is hard to resist."
So I donít
leave readers who take cholesterol-lowering medications hanging
on the subject of what does cause heart disease and what can be
done to prevent it, I have listed my series of reports posted at
LewRockwell.com archives, for your viewing (below).
him mail] is a frequent writer on health and political
topics. His health writings can be found at www.naturalhealthlibrarian.com.
latest book is Downsizing
© 2012 Bill Sardi Word of Knowledge Agency, San Dimas, California.
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